The Lapidus procedure as salvage after failed surgical treatment of hallux valgus: a prospective cohort study.

BACKGROUND: Recurrent hallux valgus is a relatively common, yet challenging, condition for both the patient and the surgeon. The literature on the treatment of recurrent hallux valgus is sparse. The purpose of this study was to evaluate prospectively the functional outcome and patient satisfaction following the Lapidus procedure for the treatment of recurrent hallux valgus deformity.

METHODS: Twenty-four patients with a total of twenty-six symptomatic recurrences of hallux valgus after previous procedures for treatment of the deformity were included in the study. Exclusion criteria included prior fusion procedures on the foot or ankle, a previous Keller or Mayo procedure, insulin-dependent diabetes, peripheral vascular disease, or peripheral neuropathy. A visual analog pain scale and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale were administered preoperatively, at six months postoperatively, and yearly thereafter. Weight-bearing radiographs were also made preoperatively; at six weeks, three months, six months, and one year postoperatively; and yearly thereafter. Patient satisfaction was assessed at the latest follow-up evaluation.

RESULTS: At twenty-four months, the mean score according to the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale had increased from 47.6 to 87.9 points, the mean score according to the visual analog pain scale had improved from 6.2 to 1.4, the mean hallux valgus angle had improved from 37.1 degrees to 17.1 degrees, and the mean intermetatarsal angle had improved from 18 degrees to 8.6 degrees. The patients were very satisfied after 77% of the twenty-six procedures, satisfied after 4%, and somewhat satisfied after 19%; no patient was dissatisfied. There were no cases of hallux varus. Complications included three nonunions, all of which occurred in smokers, and two superficial wound infections.

CONCLUSION: In appropriately selected patients, the Lapidus procedure is a reliable and effective operation after failed surgical treatment of hallux valgus.

LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.